Provider Demographics
NPI:1528768124
Name:JOHANSEN, JANET ELAINE
Entity type:Individual
Prefix:
First Name:JANET
Middle Name:ELAINE
Last Name:JOHANSEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4909 COLONIAL DR
Mailing Address - Street 2:
Mailing Address - City:MECHANICSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17055-4804
Mailing Address - Country:US
Mailing Address - Phone:732-703-4797
Mailing Address - Fax:
Practice Address - Street 1:4909 COLONIAL DR
Practice Address - Street 2:
Practice Address - City:MECHANICSBURG
Practice Address - State:PA
Practice Address - Zip Code:17055-4804
Practice Address - Country:US
Practice Address - Phone:732-703-4797
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-03
Last Update Date:2023-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL012396235Z00000X
NJ41YS00371200235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist